Amendment 00001 SF-30.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGES

2. AMENDMENT/MODIFICATION NO.

00001

3. EFFECTIVE DATE

25th March 2021

4. REQUISITION/PURCHASE REQ. NO.

PR9271309

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE

7. ADMINISTERED BY (If other than Item 6)

CODE

AMERICAN EMBASSY LONDON

33 NINE ELMS LANE, ATTN: GSO/PROCUREMENT

LONDON

SW11 7US UNITED KINGDOM

AMERICAN CONSULATE GENERAL HAMILTON

CROWN HILL 16 MIDDLE ROAD

ATTN: FMC

DEVONSHIRE, DV03

BERMUDA

8. NAME AND ADDRESS OF CONTRACTOR (NO., street,city,county,State,and ZIP Code)

9a. AMENDMENT OF SOLICITATION NO.

19UK5621R00002

9b. DATED (SEE ITEM 11)

19th February 2021

10a. MODIFICATION OF CONTRACT/ORDER NO.

10b. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

[ ] is extended, [ X ] is not extended

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing Items 8 and 15, and returning ____One___ copies of the amendment;

(b) By acknowledging receipt of this amendment on each copy of the offer submitted; or

(c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers.

FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF

OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b)

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor [ ] is not, [ ] is required to sign this document and return ___ copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this Amendment is to add the requirement for claims to be paid out in Bermuda Dollars to Section H.4 of the solicitation document and to update the table Exhibit C and add in Exhibits D, E and F.

SEE NEXT PAGE

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

16A. NAME OF CONTRACTING OFFICER

15B. NAME OF CONTRACTOR/OFFEROR

BY

(Signature of person authorized to sign)

15C.DATE

SIGNED

16B. UNITED STATES OF AMERICA

BY

(Signature of Contracting Officer)

16C.DATE SIGNED

NSN 7540-01-152-8070 Standard Form 30 (revised 10/83) Previous edition unusable Prescribed by GSA FAR (48 CFR) 53.243

19UK5621R0002 – Amendment 00001

1. The purpose of this Amendment is to add the requirement for claims to be paid out in Bermuda Dollars to Section H.4 of the solicitation document as follows.

2. Section H.4 of the solicitation document is hereby updated to read as follows:

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

General.

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

(a) Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) Settlement shall be by issuance of checks in the name of the employee, or electronic direct deposit payment to employee’s bank account, for each claim submitted. Employee will be notified via a health claim notification of payment providing details of the amount reimbursed with an explanation of deductions, if any.

(5) All settlements will be made to employees in Bermuda Dollars.

(b) Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks, in Bermuda Dollars in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

3. Exhibit C is to be replaced in its entirety with the following table:

EXHIBIT C – CLAIMS HISTORY

YEAR

TOTAL BERMUDA $ TOTAL USD $

2016 $ 182,633.00 $ 182,633.00 2017 $ 237,287.00 $ 237,287.00 2018 $ 191,724.54 $ 191,724.54 2019 $ 263,516.32 $ 263,516.32 2020 $ 120,813.71 $ 120,813.71

4. Exhibit D is added to the solicitation:

EXHIBIT D - CLAIMS EXPERIENCE

Reporting Period Insurance Premium Claims Incurred Loss ratio MRF 2020 Calendar Year $318,535.91 $120,812.72 38% $117,849.35

2019 Calendar Year $354,108.23 $263,516.32 74% $83,527.23

2018 Calendar Year $441,652.35 $191,724.54 43% $37,740.30

5. Exhibit E is added to the solicitation

EXHIBIT E - ANNUAL NET PREMIUM, INCURRED CLAIMS AND MEMBERSHIP HISTORY

All amounts in BDS – Exchange rate – BD$1.00 = USD$1.00

Contract Year Total Claims Paid

Total Premium Paid to Insurer Net Gain

2016 $ 182,633.00 $ 359,220.00 $ 176,587.00

2017 $ 237,287.00 $ 419,171.00 $ 181,884.00

2018 $ 191,724.54 $ 441,652.35 $ 249,927.81

2019 $ 263,516.32 $ 354,108.23 $ 90,591.91

2020 $ 120,813.71 $ 318,535.91 $ 197,722.20

6. Exhibit F is added to the solicitation

EXHIBIT F – STATISTICS

Employee Coverage at end of Coverage Year

Year Employee Only Employee and Child(ren)

Employee, Spouse and Child(ren)

2016 16 8 1

2017 17 7 2

2018 18 8 2

2019 18 6 2

2020 18 6 2